NPI | 1285706556 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004195) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002076) |
Enumeration Date | 2006-11-14 |
Last Update Date | 2020-11-30 |